Cancer Res Treat.  2008 Dec;40(4):202-206.

A Case of Medullary Thyroid Carcinoma in which the Skin Metastasis was Concurrently Present and Response Occurred to Chemotherapy

• Choi WJ
• Lee YY
• Kim S
• Kim YK
• Kim ES
• Seo SO
• Jo JH
• Lee SM
• Lee HJ

Abstract

Medullary thyroid carcinoma accounts for 3% of all thyroid gland malignancies. It commonly metastasizes to liver, lung, and bone. It rarely metastasizes to skin, and only a few such cases have been documented. Cutaneous metastasis suggests a poor prognosis, with a mean survival of 7.5-19 months. The most effective treatment for skin metastasis is complete surgical removal of all local and regional lesions. The response to systemic chemotherapy is typically poor. We report a case of medullary thyroid carcinoma with cutaneous metastases, which responded to chemotherapy.

Keyword

Medullary thyroid carcinoma; Cutaneous metastases; Chemotherapy

MeSH Terms

Liver
Lung
Neoplasm Metastasis
Prognosis
Skin
Thyroid Gland
Thyroid Neoplasms

Figure

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  Fig. 1 The decreased size of metastatic skin lesions (A) prior to chemotherapy (B) on the 4th cycle following the chemotherapy (C), (D) on the 13th cycle following the chemotherapy (the largest nodule, from 2.5×1.5 cm2 to 0.8×0.6 cm2)

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  Fig. 2 A computed tomography of the neck (contrast enhancement) (A, B) Several lymph nodes which were non-specifically enlarged were observed in bilateral neck areas. (B) A low-density area which was suspected to be cancer was observed in the right lobe of thyroid gland.

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  Fig. 3 FDG PET/CT scan. (A) Initial scan showed multiple hypermetabolic foci in the neck, mediastinum and axillary lymph nodes including borderline hypermetabolism of the right lobe of thyroid gland. (B) A follow-up scan (following the 5th chemotherapy) showed decreased metabolism & size in neck masses including axillary lymph nodes.

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  Fig. 4 Histopathologic and immunohistochemical findings. (A) A fine needle aspiration biopsy: Aggregates of tumor cells having enlarged & hyperchromatic nuclei which are suggestive of the possibility of medullary carcinoma of the thyroid gland. (B) Cervical lymph nodes: Mostly replaced by tumor cells. Tumor cells infiltrated into the adjacent soft tissue. (C) The soft tissue around the lymph nodes: Tumor featuring a calcitonin-positive staining property. (D) Metastatic skin lesions of the neck: Tumor featuring a calcitonin-positive staining property

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  Fig. 5 Time-dependent changes of serum calcitonin (period of chemotherapy: June of 2006~May of 2007)

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